What is the clinical evidence from this study?

Study design: Observational. Population: Acute Myocardial Infarction (n=2981). Intervention: Female sex vs. Male sex. Primary outcome: In-hospital mortality (OR 1.01, 95% CI 0.47-2.04, p=0.69).

January 1, 2006Open Access

Sex Differences in Early Mortality of Patients Undergoing Primary Stenting for Acute Myocardial Infarction

Key Result

Although women had a higher unadjusted in-hospital mortality rate than men (9.4% vs 5.2%), female sex was not an independent predictor of in-hospital death after adjusting for baseline differences (OR 1.01).

Study Design

Type

Observational (n=2,981)

Multicenter

Yes

Structured PICO

Does female sex independently predict higher in-hospital mortality in patients undergoing primary stenting for acute myocardial infarction?

Population

2,981 patients with acute myocardial infarction who underwent emergency primary stenting within 24 hours of symptom onset, evaluated for in-hospital outcomes.

Exposure

Female sex (observational exposure)

Comparator

Male sex

Outcome

In-hospital mortalityhard clinical

Women undergoing primary stenting for AMI have higher unadjusted in-hospital mortality than men, but this difference is driven by baseline clinical characteristics and comorbidities rather than female sex itself.

Main Result

Odds Ratio: 1.01 (95% CI 0.47–2.04)

Absolute Event Rate: 9.4% vs 5.2%

p-value: p=0.69

Limitations

Retrospective, observational, non-randomized study design
Lack of information on medical treatments such as aspirin, statins, beta-blockers, ACE inhibitors, and ARBs
Lack of data on door-to-balloon time
Lack of detailed angiographic data such as number of stenosed lesions, lesion length, and reference diameter
Cardiac and non-cardiac causes of death were not fully examined

Abstract

BACKGROUND: Limited information exists regarding the impact of gender on in-hospital outcome after primary stenting for acute myocardial infarction (AMI). METHODS AND RESULTS: A total of 2,981 patients (790 women and 2,191 men) participated in the study who were admitted within 24 h after symptom onset and underwent emergency primary stenting for AMI. Compared with men, women were significantly older; had higher incidences of hypertension, diabetes mellitus, hyperlipidemia, Killip class > or =2, and cardiogenic shock; had a higher blood glucose level and a lower serum creatinine level on admission. Other baseline characteristics, including the incidences of ST-segment elevation AMI, anterior infarction, 3-vessel disease, initial or final Thrombolysis in Myocardial Infarction (TIMI) flow grade did not significantly differ between the sexes. The in-hospital mortality rate was significantly higher in women than in men (9.4% vs 5.2%, p<0.001). On multivariate analysis, age, Killip class, blood glucose level, serum creatinine level, and final TIMI grade were independent predictors of in-hospital death, but female gender was not (odds ratio 1.01, p=0.69). CONCLUSIONS: Our findings suggest that in patients undergoing primary stenting for AMI, women have higher in-hospital mortality than men, but female gender itself is not independently associated with increased in-hospital mortality after adjustment for baseline differences.

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